For many women, obstetric fistula leads to a range of complex and long-term health complications. We spoke with Dr Leta Gadafa about the lengthy and delicate process of restoring health and dignity to Sumaya, a mother of ten.
Dr Leta Gadafa is an obstetrician-gynaecologist, fistula surgeon and Manager at Hamlin’s Harar Fistula Hospital, where he has worked for more than six years. One of his recent patients was Sumaya, a woman from Golawah who developed an obstetric fistula following the birth of her eleventh child.
Sumaya arrived at Harar hospital two months after the injury occurred. Dr Leta explains what happened next: “Sumaya went into labour at home, but the delivery was extremely difficult. After labouring for three days, her family carried her to the local mosque to seek help.
“In this part of Ethiopia, there is no transport infrastructure—no cars and no nearby roads. Eventually, she was carried on a traditional stretcher by family members to the nearest government hospital. By then, her baby had died, and Sumaya required emergency surgery.”
Multiple complications after prolonged labour
For Sumaya, this marked the beginning of a long and agonising journey. During surgery, her uterus was removed, and she lost a significant amount of blood. She remained unconscious for two days. When she awoke, she discovered she could no longer control her urine and was unable to move her right leg.
“Sumaya was suffering from multiple complications caused by prolonged obstructed labour,” says Dr Leta. “She developed obstetric fistula, foot drop neuropathy, and a contracture of the knee joint.”
Dr Leta explains that foot drop can occur during prolonged labour when prolonged pressure on the sciatic nerve disrupts nerve signalling. As a result, the patient is unable to properly lift the foot, causing it to drop when walking.
“The good news is that, in many cases, it can be improved through physiotherapy and targeted exercises.”
Improvement can take time, however. Dr Leta estimates that progress is usually over three to six months, and in some cases patients may be left with a permanent limp.
Referred to specialised fistula care
Fortunately, Sumaya was referred by the government hospital to Hamlin’s Harar Fistula Hospital for specialist treatment and care. After a two-month period of stabilisation, she was finally well enough to travel.
“When Sumaya arrived, she was anaemic, malnourished, and suffering from infection,” explains Dr Leta. “We began physiotherapy to address the foot drop, provided iron treatment for her anaemia, and treated the infection.” – Dr Leta
Once Sumaya’s health stabilises
The next stage of her care will involve surgery to close the obstetric fistula. Only after this can she begin broader rehabilitation activities. Dr Leta estimates that Sumaya may remain in Hamlin’s care for at least a year before she is ready to return home.
Once her health stabilises, Sumaya will be able to participate in the customised rehabilitation and reintegration programs offered through Desta Mender.
These programs support women recovering from fistula to rebuild their lives with dignity and choice, offering literacy and numeracy education, vocational skills training, counselling, and psychosocial support.
For Dr Leta, much of Sumaya’s suffering was preventable.
“Poverty, limited education, and under-resourced health systems all contribute to situations like this,” he says. “Girls need access to education, reproductive health information, and family planning services. This was Sumaya’s eleventh pregnancy, which tells us she did not have access to contraception or the ability to plan her pregnancies.”
He adds that the absence of skilled care during childbirth was critical.
Ending obstetric fistula: treatment and prevention
Dr Leta firmly believes that obstetric fistula can be eliminated.
“We need to do two things: identify women living with fistula and provide treatment and prevent fistula from occurring in the first place. This requires more skilled midwives, functional health centres, and strong referral systems.”
He notes that Project Zero plays a vital role in both areas—identifying women living with untreated childbirth injuries while also strengthening the quality of obstetric care in rural communities.
This work is grounded in a simple but powerful principle: every woman has the right to give birth safely, with skilled care, dignity and respect, no matter where she lives.
